Deep vein thrombosis in spinal cord injury: effect of prophylaxis with calf compression, aspirin,and dipyridamole

Green, David; Rossi, Ennio C.; Yao, James S.T.; Flinn, William R.; Spies, Stewart

doi:10.1038/sc.1982.41

Cited by 71 publications

(30 citation statements)

References 16 publications

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“…Nineteen other trials enrolled diverse groups of moderately to severely injured patients, including eight trials in patients with spinal cord injury 30,[166][167][168][169][170][171][172] and four studies in patients with orthopedic injuries. [173][174][175][176] Studies evaluated both mechanical (eg, IPC, myostimulation, continuous passive motion) and pharmacologic (eg, LDUH, LMWH) interventions, but no randomized trials examined IVC fi lter placement or use of surveillance ultrasound.…”

Section: Explanation Of Evidence Profi Lesmentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,853

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Explanation Of Evidence Profi Lesmentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,853

744

View full text Add to dashboard Cite

show abstract

“…1,2 Depending on diagnostic methods used, rates of deep venous thrombosis (DVT) are reported between 10 and 50% in this specific patient population. [3][4][5][6][7] DVTs were detected in 20% of patients admitted to rehabilitation facilities. 8,9 Predictors for the development of DVT are male sex, length of hospitalization, comorbidities, and severity of injuries.…”

Section: Received 13 August 2008; Accepted 3 August 2009mentioning

confidence: 99%

Serial compression B‐scan and Doppler sonography for the screening of deep venous thrombosis in patients with spinal cord injuries

Germing¹,

Schakrouf²,

Lindstaedt³

et al. 2009

J of Clinical Ultrasound

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“…Outcomes have been better when treatment protocols used a combination of measures that targeted various risk factors individually. 1,2 Di erent protocols using oral anticoagulants, heparin, low molecular weight heparins, vena caval ®lters and antithromboembolic stockings have been demonstrated to provide e ective prophylaxis in patients with spinal cord injuries. 3 Low molecular weight heparins (LMWH) were introduced in the later half of the eighties.…”

Section: Introductionmentioning

confidence: 99%

A comparison of heparin/warfarin and enoxaparin thromboprophylaxis in spinal cord injury: the Sheffield experience

et al. 2002

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Objectives: To compare the safety and e ectiveness of two di erent thromboprophylactic protocols in the management of patients with spinal cord injury ± one using heparin/warfarin and the other using enoxaparin. Study design: Retrospective. Setting: Princess Royal Spinal Injuries Unit, She eld, UK. Methods: Retrospective review of two cohorts of patients with acute spinal injury admitted to a supra-regional spinal injuries centre and treated with di erent pharmacological agents. One group received heparin/warfarin in combination with antiembolism stockings and mechanical measures for thromboprophylaxis whereas the second group received enoxaparin in combination with the other measures. Patients who developed clinical symptoms suggestive of deep vein thrombosis or pulmonary embolism were investigated as appropriate. Results: Four of the 101 patients on heparin/warfarin developed symptoms of venous thromboembolism compared to 13 of the 72 who were on enoxaparin. Of the 13, three had been on 40 mg of enoxaparin daily and 10 on 20 mg enoxaparin daily. Six patients on enoxaparin and one patient on warfarin developed thromboembolic complications after they had been mobilised and the anticoagulant discontinued. Eight patients on warfarin prophylaxis and three patients on enoxaparin developed haemorrhagic complications necessitating cessation of therapy. Conclusion: This study suggests that the traditional protocol of warfarin/heparin for thromboprophylaxis in spinal cord injury patients remains a safer option than enoxaparin.

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Deep vein thrombosis in spinal cord injury: effect of prophylaxis with calf compression, aspirin,and dipyridamole

Cited by 71 publications

References 16 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

Serial compression B‐scan and Doppler sonography for the screening of deep venous thrombosis in patients with spinal cord injuries

A comparison of heparin/warfarin and enoxaparin thromboprophylaxis in spinal cord injury: the Sheffield experience

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